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Choi YJ, Kim TJ, Bang CS, Lee YK, Lee MW, Nam SY, Shin WG, Seo SI. Changing trends and characteristics of peptic ulcer disease: A multicenter study from 2010 to 2019 in Korea. World J Gastroenterol 2023; 29:5882-5893. [PMID: 38111504 PMCID: PMC10725564 DOI: 10.3748/wjg.v29.i44.5882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The clinical trend and characteristics of peptic ulcer disease (PUD) have not fully been investigated in the past decade. AIM To evaluate the changing trends and characteristics of PUD according to age and etiology. METHODS We analyzed seven hospital databases converted into the Observational Medical Outcomes Partnership-Common Data Model between 2010 and 2019. We classified patients with PUD who underwent rapid urease tests or Helicobacter pylori (H. pylori) serology into three groups: H. pylori-related, drug [nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin]-related, and idiopathic (H. pylori/NSAID/aspirin-negative) PUD and compared the yearly trends and characteristics among the three groups. RESULTS We included 26785 patients in 7 databases, and the proportion of old age (≥ 65 years) was 38.8%. The overall number of PUD exhibited no decrease, whereas PUD in old age revealed an increasing trend (P = 0.01 for trend). Of the 19601 patients, 41.8% had H. pylori-related, 36.1% had drug-related, and 22.1% had idiopathic PUD. H. pylori-related PUD exhibited a decreasing trend after 2014 (P = 0.01), drug-related PUD demonstrated an increasing trend (P = 0.04), and idiopathic PUD showed an increasing trend in the old-age group (P = 0.01) during 10 years. Patients with drug-related PUD had significantly more comorbidities and concomitant ulcerogenic drugs. The idiopathic PUD group had a significantly higher number of patients with chronic liver disease. CONCLUSION With the aging population increase, the effects of concomitant ulcerogenic drugs and preventive strategies should be investigated in drug-induced PUD. Further studies are required to clarify the relationship between idiopathic PUD and chronic liver disease.
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Affiliation(s)
- Yoon Jin Choi
- Department of Internal Medicine, National Cancer Center, Goyang-si 13620, South Korea
| | - Tae Jun Kim
- Department of Internal Medicine, Samsung Medical Center, Seoul 06351, South Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon 24253, South Korea
| | - Yong Kang Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si 10444, South Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 50463, South Korea
| | - Su Youn Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, South Korea
| | - Seung In Seo
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, South Korea
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, South Korea
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Santos Lucio A, Rodríguez Tirado I, Aparicio Serrano A, Jurado García J, Barrera Baena P, González Galilea Á, Poyato González A, Pleguezuelo Navarro M, Costán Rodero G, Casáis Juanena L, Montero Álvarez JL, de la Mata M, Hervás Molina AJ, Rodríguez-Perálvarez ML. Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:450-456. [PMID: 34400186 DOI: 10.1016/j.gastrohep.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
AIM To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. PATIENTS AND METHODS Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. RESULTS A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). CONCLUSION Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.
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Affiliation(s)
- Ana Santos Lucio
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Isabel Rodríguez Tirado
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Ana Aparicio Serrano
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Juan Jurado García
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Pilar Barrera Baena
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Ángel González Galilea
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Antonio Poyato González
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - María Pleguezuelo Navarro
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Guadalupe Costán Rodero
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Luis Casáis Juanena
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - José Luis Montero Álvarez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España
| | - Manuel de la Mata
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, España
| | - Antonio José Hervás Molina
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España
| | - Manuel Luis Rodríguez-Perálvarez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, España; CIBER de enfermedades hepáticas y digestivas (CIBERehd), Madrid, España; Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, España.
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Shah H, Yang TJ, Wudexi I, Solanki S, Patel S, Rajan D, Rodas A, Dajjani M, Chakinala RC, Shah P, Sarker K, Patel A, Aronow W. Trends and outcomes of peptic ulcer disease in patients with cirrhosis. Postgrad Med 2020; 132:773-780. [PMID: 32654578 DOI: 10.1080/00325481.2020.1795485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. METHODS We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002-2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes. RESULTS Between the years 2002-2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63-1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 - 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis. CONCLUSION Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes.
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Affiliation(s)
- Harshil Shah
- Internal Medicine, Guthrie Robert Packer Hospital , Sayre, Pennsylvania, United States
| | - Tsu Jung Yang
- MultiCare Good Samaritan Hospital , Puyallup, Washington, United States
| | - Ivan Wudexi
- Internal Medicine, University at Buffalo/Catholic Health System , Buffalo, New York, United States
| | - Shantanu Solanki
- Internal Medicine, Guthrie Robert Packer Hospital , Sayre, Pennsylvania, United States
| | - Shakumar Patel
- Internal Medicine, Ocean Medical Center , Brick, New Jersey, United States
| | - Don Rajan
- Internal Medicine, UTRGV Doctors' Hospital at Renaissance , Edinburg, Texas, United States
| | - Aaron Rodas
- Internal Medicine, Pontiac General Hospital , Pontiac, Michigan, United States
| | - Mousa Dajjani
- Internal Medicine, Pontiac General Hospital , Pontiac, Michigan, United States
| | | | - Priyal Shah
- Internal Medicine, Medical Center Navicent Health , Macon, Georgia, United States
| | - Khadiza Sarker
- Internal Medicine, Carle Foundation Hospital , Urbana, Illinois, United States
| | | | - Wilbert Aronow
- New York Medical College, Cardiology Division, New York Medical College Macy Pavilion , Valhalla, New York, United States
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Qu WF, Zhou PY, Liu WR, Tian MX, Jin L, Jiang XF, Wang H, Tao CY, Fang Y, Zhou YF, Song SS, Ding ZB, Peng YF, Dai Z, Qiu SJ, Zhou J, Fan J, Tang Z, Shi YH. Age-adjusted Charlson Comorbidity Index predicts survival in intrahepatic cholangiocarcinoma patients after curative resection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:487. [PMID: 32395531 PMCID: PMC7210176 DOI: 10.21037/atm.2020.03.23] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Comorbidity among cancer patients is prevalent and influential to prognosis after operation. Limited data are available on comorbidity evaluations in patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to assess the comorbidity distribution in ICC patients and to adapt the Charlson Comorbidity Index (CCI) or the age-adjusted CCI (ACCI) for survival prediction. Methods The study cohort included 268 ICC patients treated with curative surgery from January 2000 to December 2007 at the Department of Liver Surgery, Zhongshan Hospital. The association between the comorbidity index and overall survival (OS) or disease-free survival (DFS). was analyzed by the Kaplan-Meier method. Multivariable analysis was established to select the determinant parameters. Results Major comorbid conditions of ICC patients included liver disease, hypertension, diabetes and ulcer. The median follow-up time was 25.5 months in the whole data set. Among the entire cohort, the 1-, 3- and 5-year OS rates were 55.3%, 26.0% and 15.6%, respectively. In multivariate analysis, the ACCI correlated with OS, and higher scores were associated with poorer prognosis (hazard ratio =1.134, 95% confidence interval: 1.015–1.267 and P value =0.026). CCI was not an independent predictive factor for OS or DFS. Conclusions In contrast to CCI, ACCI was a more promising model to accurately predict OS in ICC patients who underwent liver resection. Further research should be focused on the impact of comorbidity therapies.
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Affiliation(s)
- Wei-Feng Qu
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Pei-Yun Zhou
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Wei-Ren Liu
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Meng-Xin Tian
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Lei Jin
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Xi-Fei Jiang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Han Wang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Chen-Yang Tao
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Yuan Fang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Yu-Fu Zhou
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Shu-Shu Song
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Zhen-Bin Ding
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Yuan-Fei Peng
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Zhi Dai
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Shuang-Jian Qiu
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Jian Zhou
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Jia Fan
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Zheng Tang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
| | - Ying-Hong Shi
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China
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Voulgaris T, Karagiannakis D, Siakavellas S, Kalogera D, Angelopoulos T, Chloupi E, Karamanolis G, Papatheodoridis G, Vlachogiannakos J. High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis. Ann Gastroenterol 2019; 32:451-456. [PMID: 31474790 PMCID: PMC6686096 DOI: 10.20524/aog.2019.0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH). Methods: We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data. Results: One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection. Conclusions: A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation.
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Affiliation(s)
- Theodoros Voulgaris
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Spyridon Siakavellas
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Despina Kalogera
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Theodoros Angelopoulos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Elissavet Chloupi
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Karamanolis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Papatheodoridis
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - John Vlachogiannakos
- Academic Department of Gastroenterology and Hepatology, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
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Daure E, Ross L, Webster CRL. Gastroduodenal Ulceration in Small Animals: Part 1. Pathophysiology and Epidemiology. J Am Anim Hosp Assoc 2017; 53:1-10. [DOI: 10.5326/jaaha-ms-6635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Gastroduodenal ulceration in small animals is a complex and important comorbidity that occurs when the physiological homeostasis of the gastrointestinal tract is disrupted secondary to administration of medications or the presence of local or systemic diseases. The aim of this article is to provide a comprehensive review of the veterinary literature regarding the pathophysiology, epidemiology, and risk factors associated with gastroduodenal ulceration in small animals. Pertinent concepts from the human literature will be integrated into the discussion. This article serves as an introduction to the second part of this series, which will review current evidence regarding the use of H2-receptor antagonists and proton pump inhibitors in small animals.
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Affiliation(s)
- Evence Daure
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
| | - Linda Ross
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
| | - Cynthia R. L. Webster
- From the Centre Vétérinaire Daubigny, Quebec, Canada (E.D.); and the Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts (L.R., C.R.L.W.)
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Nojkov B, Cappell MS. Distinctive aspects of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss syndrome in patients with advanced alcoholic liver disease or cirrhosis. World J Gastroenterol 2016; 22:446-466. [PMID: 26755890 PMCID: PMC4698507 DOI: 10.3748/wjg.v22.i1.446] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/11/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically review the data on distinctive aspects of peptic ulcer disease (PUD), Dieulafoy’s lesion (DL), and Mallory-Weiss syndrome (MWS) in patients with advanced alcoholic liver disease (aALD), including alcoholic hepatitis or alcoholic cirrhosis.
METHODS: Computerized literature search performed via PubMed using the following medical subject heading terms and keywords: “alcoholic liver disease”, “alcoholic hepatitis”,“ alcoholic cirrhosis”, “cirrhosis”, “liver disease”, “upper gastrointestinal bleeding”, “non-variceal upper gastrointestinal bleeding”, “PUD”, ‘‘DL’’, ‘‘Mallory-Weiss tear”, and “MWS’’.
RESULTS: While the majority of acute gastrointestinal (GI) bleeding with aALD is related to portal hypertension, about 30%-40% of acute GI bleeding in patients with aALD is unrelated to portal hypertension. Such bleeding constitutes an important complication of aALD because of its frequency, severity, and associated mortality. Patients with cirrhosis have a markedly increased risk of PUD, which further increases with the progression of cirrhosis. Patients with cirrhosis or aALD and peptic ulcer bleeding (PUB) have worse clinical outcomes than other patients with PUB, including uncontrolled bleeding, rebleeding, and mortality. Alcohol consumption, nonsteroidal anti-inflammatory drug use, and portal hypertension may have a pathogenic role in the development of PUD in patients with aALD. Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients. The frequency of bleeding from DL appears to be increased in patients with aALD. DL may be associated with an especially high mortality in these patients. MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism, and is associated with aALD. Patients with aALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics. Pre-endoscopic management of acute GI bleeding in patients with aALD unrelated to portal hypertension is similar to the management of aALD patients with GI bleeding from portal hypertension, because clinical distinction before endoscopy is difficult. Most patients require intensive care unit admission and attention to avoid over-transfusion, to correct electrolyte abnormalities and coagulopathies, and to administer antibiotic prophylaxis. Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal. Prompt endoscopy, after initial resuscitation, is essential to diagnose and appropriately treat these patients. Generally, the same endoscopic hemostatic techniques are used in patients bleeding from PUD, DL, or MWS in patients with aALD as in the general population.
CONCLUSION: Nonvariceal upper GI bleeding in patients with aALD has clinically important differences from that in the general population without aALD, including: more frequent and more severe bleeding from PUD, DL, or MWS.
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